Provider Demographics
NPI:1194334466
Name:AMBASSADOR HOME CARE SERVICES LLC
Entity type:Organization
Organization Name:AMBASSADOR HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMERKHANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-258-3396
Mailing Address - Street 1:626 JACKSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-4872
Mailing Address - Country:US
Mailing Address - Phone:267-770-6729
Mailing Address - Fax:215-613-8788
Practice Address - Street 1:118080 BUSTLETON AV
Practice Address - Street 2:SUITE 301
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116
Practice Address - Country:US
Practice Address - Phone:215-486-1080
Practice Address - Fax:215-613-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1037340770001OtherHOME CARE